Combined pill
Combined contraceptive pill (oestrogen and progestogen) to prevent pregnancy from £10.60.
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- Read medical information about oral contraception
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Brands of combined pill available
About combined contraceptive pills
The combined oral contraceptive pill, also known as The Pill contains the female hormones oestrogen and progesterone, in artificial form.
Combined pills are usually taken for contraception, but can also treat heavy or painful periods, and PMS (premenstrual syndrome) and endometriosis.
The combined pill prevents pregnancy in 3 ways; preventing ovaries from releasing eggs (ovulating), reducing the chances of sperm reaching eggs, and reducing the chances of fertilised eggs implanting in the womb.
Features of the combined pill
- It is 99% effective in preventing pregnancy, if taken correctly. Only one woman in 100 taking the combined pill will become pregnant each year.
- One pill is taken daily for 21 days, followed by a break of 7 days, before restarting. A menstrual bleed normally takes place in the 7 day break.
- ED (extra day) pills come in packs of 28 tablets. 7 tablets in the packs contain no active ingredients. These non-active pills are included to make up the 7 day break as some women may find it easier to not break the routine of taking a daily pill.
- The pill is best taken at the same time each day, and may not work if pills are missed or vomited or in severe diarrhoea.
- Some women on the combined pill experience mood swings, breast tenderness and headaches. See individual patient information leaflets for details of side effects.
- The combined pill is not recommended for women over 35 who smoke, because of the increased thrombosis risk.
- Women taking contraception should have a pill check-up with their surgery GP or nurse, usually 12 monthly.
- It is important that cervical smears are up-to-date.
- Women who are at risk of sexually transmitted diseases should use condoms in addition to their pills. If in doubt, condoms should be used. Condoms should be used in addition to your pill to protect against sexually transmitted diseases with a new partner until you have both been checked.
Choice of pill
There are numerous different brands of combined pills available from different pharmaceutical companies, with differing amounts and types of oestrogen and progesterone. Some pills will contain the same ingredient in every pill (monophasic 21 day pills), others have varying combinations of oestrogen and progesterone through the cycle of 21 pills.
Women, working together with doctors or specialist contraceptive nurses, can usually find a pill which suits them. Dr Fox provides only continuation of existing contraception, not first time contraception or changes to existing contraception.
Dr Fox provides only continuation of existing contraception, not first time contraception or changes to existing contraception.
How to take combined pills
Advice about how to take the pill is usually given by doctor or nurse who first prescribed it. Information can also be found in the patient information leaflet supplied with each pill pack. Most women can start the pill at any time in their cycle, although additional contraception in the first days may be required, depending on where in the cycle the pill was started. Your doctor or specialist nurse can advise. There is also further information at NHS Choices: Contraception guide - Combined pill.
Taking pill packs without a break
Occasionally doctors may advise women to take combined pills without a 7 day pill-free break. This is often done for two or more cycles, and is particularly useful to delay the onset of a period, for example when a woman is planning a holiday. It may also be useful for women who have painful periods. Taking pills without a break should only be done under medical supervision, as it can lead to breakthrough bleeding and some women experience bloating and other side effects.
Taking combined pills without pill-free days, although not unusual, is not covered by the medicines licensing. It is an off-license use of the medicine.
Missed a pill
If pills are missed, there is an increased risk of pregnancy. The rules about what to do when a pill is missed are complicated. What to do depends on how many pills are missed and where in the cycle. Details can be found at NHS Choices: Contraception guide - Combined pill and our article Missed a Pill? Here's what to do. You can also call NHS 111 or the Sexual Health Line on 0300 123 7123.
If vomiting occurs within two hours, take another pill and the next pill at your usual time.
Is the combined pill suitable?
Dr Fox supplies only 3 months of the oral contraceptive pill at a time, and only to those 18-50 years who have already been taking their pill for a year.
Most women, who do not smoke, can take the combined pill right up to the menopause. In general, all women can cease contraception at age 55 as spontaneous conception after this age is exceptionally rare even in women still experiencing menstrual bleeding.
Women who have had a baby and are not breastfeeding can start the pill after 21 days. Women who are breastfeeding on demand up to 6 months do not normally require contraception, as they are unlikely to become pregnant, although up to 2% do become pregnant. See here for more details. The combined pill can be started safely 6 weeks after childbirth. Taking the pill will reduce the flow of milk. The pill can be started 5 days after a miscarriage or abortion.
Some medicines interact with the combined pill and may alter its effectiveness. The rarely prescribed antibiotics rifampicin and rifabutin can make the pill ineffective and stronger pills may be required. Most other antibiotics have a minimal effect, and no additional contraception is required unless there is vomiting and diarrhoea.
The combined pill could possibly very slightly increase the risks of some cancers and reduce the risk of others, more details at NHS Choices: Contraception guide - combined pill
The pill can slightly increase the chance of blood clots, particularly in women who have other risk factors. The risks vary from one pill to another. Checks on suitability will be carried out when the pill is first prescribed by a health professional.
Under 16s requiring contraception should see a doctor or nurse, and this can be without parents being informed, as long there is good understanding and the young person is not vulnerable and in need of protection. More information at the Sexual Health Line on 0300 123 7123.
Start orderAuthored 31 December 2015 by Dr Tony Steele
Reviewed 12 February 2018 by Dr B. Babor, Dr A. Wood, Dr P. Hunt
Last updated 3 March 2018
The order process
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Customer reviews
Supplementary information
Importance of annual pill checks
Contraceptive pill FAQs
Combined contraceptive pill
Progestogen-only pill
Choosing a contraceptive pill
Morning after pill FAQs
Brook sexual health services
Smear test embarrassment?
Guide to smear tests
Effect of vomiting and diarrhoea on medication
Can I trust my contraceptive?
Talk choice - contraceptive choice
